上顎洞手術の局所麻酔によって眼球二重穿孔をきたした1例

A case of double perforation of eyeglobe during local anesthesia for maxillary sinus surgery

要約　目的：上顎洞炎の手術の際，麻酔用注射針で眼球の二重穿孔が生じた症例の報告。症例：36歳女性が右急性上顎洞炎に対し，上顎洞根治手術と歯根先端切除術を受けた。術中に上顎洞上部のとう痛があり，エピネフリン含有1％リドカインの局所浸潤麻酔を23Gカテラン針で上顎洞上壁粘膜下に追加投与し，その際に眼窩底を貫き，眼球の二重穿孔が生じた。5時間後の検査で右眼窩周囲の腫脹と散瞳があり，対光反射が消失し，視力は0.03であった。同日，穿孔部の眼底にレーザー光凝固を施行した。翌日には右眼の対光反射の遅延があったが，視力は1.2に回復し，以後順調な経過をとった。結論：副鼻腔の手術の際に眼窩内に注射針が穿孔する可能性がある。

Abstract.　Purpose：To report a case of double perforation of the eyeglobe during local anesthesia for maxillary sinus surgery. Case：A 36-year-old female received surgery for right acute maxillary sinusitis. To relieve pain in the upper portion of maxillary sinus during surgery,a 23 G catheran needle was inserted beneath the mucous membrane in the upper wall of maxillary sinus containing 1％ lidocaine with epinephrine. The needle perforated the orbital floor and induced double perforation of the right eyeglobe. This accident was followed by chemosis and mydriasis with no light reaction. Visual acuity decreased to 0.03. The site of perforation was treated by laser photocoagulation of the fundus. Visual acuity improved to 1.2 the following day. Light reaction was positive but was delayed. She has been doing ever since. Conclusion：Accidental perforation of orbital floor is a liability during parasinus surgery.